Re: Patients who refuse prostate cancer surgery have worse long-term survival

[Guest guest]

The pertinent issue for the 2009 paper referenced in the news release is

that " Within the group, 6 percent had well-differentiated cancers, 75

percent moderately differentiated cancers, and 18 percent had poorly

differentiated cancer. "

This says that only 6 percent of the group was diagnosed with 'low risk'

cancer suitable for Active Surveillance. 75 percent had intermediate risk,

and 18 percent had high risk. Given this distribution, drawing any

conclusions regarding the survival advantage of the study group by " watchful

waiting " is problematic if not disingenuous. And, the paper does not state

if the " watchful waiting " cohort was practicing Active Surveillance--

monitoring the cancer and choosing treatment upon indications it would be

appropriate-- or, whether " watchful waiting " just meant refusal of treatment

until death. Since the results covered a 15 year period, it seems likely

that most of the " watchful waiting " cohort was not following current Active

Surveillance protocols.

This issues of not appropriately stratifying patients in retrospective

treatment comparisons are all too common and is among a number of factors

leading to criticism of most news releases, if not much of current medical

literature. Unfortunately, this can mislead new patients in their difficult

process of selecting appropriate treatment. The same issues apply in trying

to draw conclusions from the news release on surgery versus radiation,

whether modern IMRT or seeds (neither were common 10 to 15 years ago).

I find it personally interesting that Dr. Mani Menon at Henry Ford is one of

the authors of the second study mentioned in the news release. It was his

advice to me when I was diagnosed in 2006 that I could consider Active

Surveillance rather than DaVinci surgery that set me on the path of

thoroughly researching all prostate cancer treatment options, and, with

rather rigorous monitoring, ended up choosing to defer treatment by Active

Surveillance. My diagnostic biopsy was a single very small Gleason 6 tumor

at PSA 5.4, with a PSA history of elevation from prostatitis. Upon my

diagnosis, I had decided on DaVinci surgery by Dr. Menon. However, after

his advice in response to my application for surgery, further investigation

showed that my early cancer clearly was in the 'low risk' group (that

apparently composed less than 6 percent of the study hyped in the Henry Ford

News release).

At age 67 and " otherwise healthy " , I'm now in my 4th year of Active

Surveillance and remain comfortable with that deferment of treatment until

such time that there is evidence of significant cancer progression.

Meanwhile, no treatment side effects and the treatment options only improve

with time.

I'd like to read a complete copy of the actual papers, not just the news

release. I suspect the news release may have overstated the actual

conclusions of the research papers.

The Best to You and Yours!

Jon in Nevada

> Message: 1

> Date: Tue, 1 Jun 2010 18:12:14 +0000 (UTC)

> From: royherren@...

> Subject: [seedPods] Patients who refuse prostate cancer surgery have

> worse long-term survival

> To: SeedPods

> Message-ID:

>

>

<1172913972.3642141275415934519.JavaMail.root@...\

..net>

>

> Content-Type: text/plain; charset=utf-8

>

> It seems based on the?author past 2009 publication (not presented in the

> following article) that the data studied?suggests a survival advantage for

> younger men (50 and under) who under go Prostatectomy, however they don't

> present the statistics for the advantage of Prostatectomy in this

> article.?? The author states " a significant number of patients refuse

> surgery and instead opt for other treatments such as radiotherapy " .? In my

> humble opinion, we can safely lump Brachytherapy into the radiotherapy

> category.? " The study found that patients who refused any treatment for

> their prostate cancer had a 10-year overall survival rate of 51 percent,

> compared to 68 percent for those who chose radiation treatment " .? What

> does this say about opting for Watchful Waiting?? On the surface it

> suggests a 17% increased survival rate at 10 years for the group that

> opted for Radiotherapy.? Therefore, if all things else are?equal, which

> they seldom are, it is rather straight forward that Radi

> otherapy is a better choice than Watchful Waiting.? However, this issue

> doesn't begin to address?the many issues of why a man might chose Watchful

> Waiting over other therapies.? It is all too easy to be dismissive of the

> choice Watchful Waiting.? Not all men are healthy enough to be candidates

> for surgery, e.g. Prostatectomy, and not all men will garner a benefit

> from Radiation therapy.? There are men, who when diagnosed with Prostate

> cancer already have pre-existing conditions that will certainly cause

> their death long before an average, slow growing, for?of ?Prostate

> cancer.? There is no benefit to be gained and potentially much harm to be

> caused by aggressively treating men for Prostate cancer who

> have?pre-existing co-morbidities!

>

> Don't get me wrong though, I do not advocate for otherwise healthy men

> electing for Watchful Waiting.? The best opportunity for curative therapy

> is early therapy!? This disease, while slow growing, is a relentless

> killer.

>

> Roy Herren

> >

> Public release date: 1-Jun-2010

> >

> Contact: Krista Hopson

> khopson1@...

>

> Henry Ford Health System

> Patients who refuse prostate cancer surgery have worse long-term survival

> >

> DETROIT ? Men who refuse surgery for prostate cancer and instead opt for

> " watchful waiting " ? monitoring cancer progression without undergoing

> treatment ? have a significantly worse long-term survival rate than those

> patients that choose radiotherapy, according to researchers at Henry Ford

> Hospital in Detroit.

>

> The study found that patients who refused any treatment for their prostate

> cancer had a 10-year overall survival rate of 51 percent, compared to 68

> percent for those who chose radiation treatment.

>

> " Surgery has been shown to offer a survival advantage to patients with

> prostate cancer when compared with other treatment options. However, a

> significant number of patients refuse surgery and instead opt for other

> treatments such as radiotherapy " says study lead author Naveen Pokala,

> M.D., an urologist at Henry Ford Hospital.

>

> The study was presented at the 2010 American Urology Association's annual

> meeting in San Francisco. >

> These findings follow a study published by Dr. Pokala in 2009 that showed

> surgery improves 5-, 10- and 15-year survival rates for men younger than

> 50 with moderately and especially in poorly differentiated prostate

> cancers, when compared with other standard treatments such as radiation

> therapy or watchful waiting.

>

> The new research, a population-based analysis of 9,704 patients chosen

> from the National SEER database, looked at survival rates among men with a

> mean age of 64.4 years, of whom 77 percent were white and 16.4 percent

> black.

>

> Of that group, nearly 30 percent refused any treatment for their prostate

> cancers, and about 70 percent chose radiation therapy.

>

> More than 70 percent of the patients were unmarried. In all, African

> American men older than 65 had the worst prognosis.

>

> Prostate cancer is second only to skin cancer as the most common cancer in

> American men, affecting one in six during his lifetime. The majority of

> the cases are in men older than 65, but it is becoming more prevalent in

> men under 40.

>

> It affects black men twice as often as whites, and their mortality rate is

> also twice as high.

>

> While curable in its early stages, symptoms often don't appear until the

> cancer has spread beyond the prostate gland itself, so annual exams for

> the disease are recommended.

>

> In addition to Dr. Pokala, study co-authors at Henry Ford Hospital

> included Peabody, M.D., and Mani Menon, M.D.

[Guest guest]

The pertinent issue for the 2009 paper referenced in the news release is

that " Within the group, 6 percent had well-differentiated cancers, 75

percent moderately differentiated cancers, and 18 percent had poorly

differentiated cancer. "

This says that only 6 percent of the group was diagnosed with 'low risk'

cancer suitable for Active Surveillance. 75 percent had intermediate risk,

and 18 percent had high risk. Given this distribution, drawing any

conclusions regarding the survival advantage of the study group by " watchful

waiting " is problematic if not disingenuous. And, the paper does not state

if the " watchful waiting " cohort was practicing Active Surveillance--

monitoring the cancer and choosing treatment upon indications it would be

appropriate-- or, whether " watchful waiting " just meant refusal of treatment

until death. Since the results covered a 15 year period, it seems likely

that most of the " watchful waiting " cohort was not following current Active

Surveillance protocols.

This issues of not appropriately stratifying patients in retrospective

treatment comparisons are all too common and is among a number of factors

leading to criticism of most news releases, if not much of current medical

literature. Unfortunately, this can mislead new patients in their difficult

process of selecting appropriate treatment. The same issues apply in trying

to draw conclusions from the news release on surgery versus radiation,

whether modern IMRT or seeds (neither were common 10 to 15 years ago).

I find it personally interesting that Dr. Mani Menon at Henry Ford is one of

the authors of the second study mentioned in the news release. It was his

advice to me when I was diagnosed in 2006 that I could consider Active

Surveillance rather than DaVinci surgery that set me on the path of

thoroughly researching all prostate cancer treatment options, and, with

rather rigorous monitoring, ended up choosing to defer treatment by Active

Surveillance. My diagnostic biopsy was a single very small Gleason 6 tumor

at PSA 5.4, with a PSA history of elevation from prostatitis. Upon my

diagnosis, I had decided on DaVinci surgery by Dr. Menon. However, after

his advice in response to my application for surgery, further investigation

showed that my early cancer clearly was in the 'low risk' group (that

apparently composed less than 6 percent of the study hyped in the Henry Ford

News release).

At age 67 and " otherwise healthy " , I'm now in my 4th year of Active

Surveillance and remain comfortable with that deferment of treatment until

such time that there is evidence of significant cancer progression.

Meanwhile, no treatment side effects and the treatment options only improve

with time.

I'd like to read a complete copy of the actual papers, not just the news

release. I suspect the news release may have overstated the actual

conclusions of the research papers.

The Best to You and Yours!

Jon in Nevada

> Message: 1

> Date: Tue, 1 Jun 2010 18:12:14 +0000 (UTC)

> From: royherren@...

> Subject: [seedPods] Patients who refuse prostate cancer surgery have

> worse long-term survival

> To: SeedPods

> Message-ID:

>

>

<1172913972.3642141275415934519.JavaMail.root@...\

..net>

>

> Content-Type: text/plain; charset=utf-8

>

> It seems based on the?author past 2009 publication (not presented in the

> following article) that the data studied?suggests a survival advantage for

> younger men (50 and under) who under go Prostatectomy, however they don't

> present the statistics for the advantage of Prostatectomy in this

> article.?? The author states " a significant number of patients refuse

> surgery and instead opt for other treatments such as radiotherapy " .? In my

> humble opinion, we can safely lump Brachytherapy into the radiotherapy

> category.? " The study found that patients who refused any treatment for

> their prostate cancer had a 10-year overall survival rate of 51 percent,

> compared to 68 percent for those who chose radiation treatment " .? What

> does this say about opting for Watchful Waiting?? On the surface it

> suggests a 17% increased survival rate at 10 years for the group that

> opted for Radiotherapy.? Therefore, if all things else are?equal, which

> they seldom are, it is rather straight forward that Radi

> otherapy is a better choice than Watchful Waiting.? However, this issue

> doesn't begin to address?the many issues of why a man might chose Watchful

> Waiting over other therapies.? It is all too easy to be dismissive of the

> choice Watchful Waiting.? Not all men are healthy enough to be candidates

> for surgery, e.g. Prostatectomy, and not all men will garner a benefit

> from Radiation therapy.? There are men, who when diagnosed with Prostate

> cancer already have pre-existing conditions that will certainly cause

> their death long before an average, slow growing, for?of ?Prostate

> cancer.? There is no benefit to be gained and potentially much harm to be

> caused by aggressively treating men for Prostate cancer who

> have?pre-existing co-morbidities!

>

> Don't get me wrong though, I do not advocate for otherwise healthy men

> electing for Watchful Waiting.? The best opportunity for curative therapy

> is early therapy!? This disease, while slow growing, is a relentless

> killer.

>

> Roy Herren

> >

> Public release date: 1-Jun-2010

> >

> Contact: Krista Hopson

> khopson1@...

>

> Henry Ford Health System

> Patients who refuse prostate cancer surgery have worse long-term survival

> >

> DETROIT ? Men who refuse surgery for prostate cancer and instead opt for

> " watchful waiting " ? monitoring cancer progression without undergoing

> treatment ? have a significantly worse long-term survival rate than those

> patients that choose radiotherapy, according to researchers at Henry Ford

> Hospital in Detroit.

>

> The study found that patients who refused any treatment for their prostate

> cancer had a 10-year overall survival rate of 51 percent, compared to 68

> percent for those who chose radiation treatment.

>

> " Surgery has been shown to offer a survival advantage to patients with

> prostate cancer when compared with other treatment options. However, a

> significant number of patients refuse surgery and instead opt for other

> treatments such as radiotherapy " says study lead author Naveen Pokala,

> M.D., an urologist at Henry Ford Hospital.

>

> The study was presented at the 2010 American Urology Association's annual

> meeting in San Francisco. >

> These findings follow a study published by Dr. Pokala in 2009 that showed

> surgery improves 5-, 10- and 15-year survival rates for men younger than

> 50 with moderately and especially in poorly differentiated prostate

> cancers, when compared with other standard treatments such as radiation

> therapy or watchful waiting.

>

> The new research, a population-based analysis of 9,704 patients chosen

> from the National SEER database, looked at survival rates among men with a

> mean age of 64.4 years, of whom 77 percent were white and 16.4 percent

> black.

>

> Of that group, nearly 30 percent refused any treatment for their prostate

> cancers, and about 70 percent chose radiation therapy.

>

> More than 70 percent of the patients were unmarried. In all, African

> American men older than 65 had the worst prognosis.

>

> Prostate cancer is second only to skin cancer as the most common cancer in

> American men, affecting one in six during his lifetime. The majority of

> the cases are in men older than 65, but it is becoming more prevalent in

> men under 40.

>

> It affects black men twice as often as whites, and their mortality rate is

> also twice as high.

>

> While curable in its early stages, symptoms often don't appear until the

> cancer has spread beyond the prostate gland itself, so annual exams for

> the disease are recommended.

>

> In addition to Dr. Pokala, study co-authors at Henry Ford Hospital

> included Peabody, M.D., and Mani Menon, M.D.

[Guest guest]

The pertinent issue for the 2009 paper referenced in the news release is

that " Within the group, 6 percent had well-differentiated cancers, 75

percent moderately differentiated cancers, and 18 percent had poorly

differentiated cancer. "

This says that only 6 percent of the group was diagnosed with 'low risk'

cancer suitable for Active Surveillance. 75 percent had intermediate risk,

and 18 percent had high risk. Given this distribution, drawing any

conclusions regarding the survival advantage of the study group by " watchful

waiting " is problematic if not disingenuous. And, the paper does not state

if the " watchful waiting " cohort was practicing Active Surveillance--

monitoring the cancer and choosing treatment upon indications it would be

appropriate-- or, whether " watchful waiting " just meant refusal of treatment

until death. Since the results covered a 15 year period, it seems likely

that most of the " watchful waiting " cohort was not following current Active

Surveillance protocols.

This issues of not appropriately stratifying patients in retrospective

treatment comparisons are all too common and is among a number of factors

leading to criticism of most news releases, if not much of current medical

literature. Unfortunately, this can mislead new patients in their difficult

process of selecting appropriate treatment. The same issues apply in trying

to draw conclusions from the news release on surgery versus radiation,

whether modern IMRT or seeds (neither were common 10 to 15 years ago).

I find it personally interesting that Dr. Mani Menon at Henry Ford is one of

the authors of the second study mentioned in the news release. It was his

advice to me when I was diagnosed in 2006 that I could consider Active

Surveillance rather than DaVinci surgery that set me on the path of

thoroughly researching all prostate cancer treatment options, and, with

rather rigorous monitoring, ended up choosing to defer treatment by Active

Surveillance. My diagnostic biopsy was a single very small Gleason 6 tumor

at PSA 5.4, with a PSA history of elevation from prostatitis. Upon my

diagnosis, I had decided on DaVinci surgery by Dr. Menon. However, after

his advice in response to my application for surgery, further investigation

showed that my early cancer clearly was in the 'low risk' group (that

apparently composed less than 6 percent of the study hyped in the Henry Ford

News release).

At age 67 and " otherwise healthy " , I'm now in my 4th year of Active

Surveillance and remain comfortable with that deferment of treatment until

such time that there is evidence of significant cancer progression.

Meanwhile, no treatment side effects and the treatment options only improve

with time.

I'd like to read a complete copy of the actual papers, not just the news

release. I suspect the news release may have overstated the actual

conclusions of the research papers.

The Best to You and Yours!

Jon in Nevada

> Message: 1

> Date: Tue, 1 Jun 2010 18:12:14 +0000 (UTC)

> From: royherren@...

> Subject: [seedPods] Patients who refuse prostate cancer surgery have

> worse long-term survival

> To: SeedPods

> Message-ID:

>

>

<1172913972.3642141275415934519.JavaMail.root@...\

..net>

>

> Content-Type: text/plain; charset=utf-8

>

> It seems based on the?author past 2009 publication (not presented in the

> following article) that the data studied?suggests a survival advantage for

> younger men (50 and under) who under go Prostatectomy, however they don't

> present the statistics for the advantage of Prostatectomy in this

> article.?? The author states " a significant number of patients refuse

> surgery and instead opt for other treatments such as radiotherapy " .? In my

> humble opinion, we can safely lump Brachytherapy into the radiotherapy

> category.? " The study found that patients who refused any treatment for

> their prostate cancer had a 10-year overall survival rate of 51 percent,

> compared to 68 percent for those who chose radiation treatment " .? What

> does this say about opting for Watchful Waiting?? On the surface it

> suggests a 17% increased survival rate at 10 years for the group that

> opted for Radiotherapy.? Therefore, if all things else are?equal, which

> they seldom are, it is rather straight forward that Radi

> otherapy is a better choice than Watchful Waiting.? However, this issue

> doesn't begin to address?the many issues of why a man might chose Watchful

> Waiting over other therapies.? It is all too easy to be dismissive of the

> choice Watchful Waiting.? Not all men are healthy enough to be candidates

> for surgery, e.g. Prostatectomy, and not all men will garner a benefit

> from Radiation therapy.? There are men, who when diagnosed with Prostate

> cancer already have pre-existing conditions that will certainly cause

> their death long before an average, slow growing, for?of ?Prostate

> cancer.? There is no benefit to be gained and potentially much harm to be

> caused by aggressively treating men for Prostate cancer who

> have?pre-existing co-morbidities!

>

> Don't get me wrong though, I do not advocate for otherwise healthy men

> electing for Watchful Waiting.? The best opportunity for curative therapy

> is early therapy!? This disease, while slow growing, is a relentless

> killer.

>

> Roy Herren

> >

> Public release date: 1-Jun-2010

> >

> Contact: Krista Hopson

> khopson1@...

>

> Henry Ford Health System

> Patients who refuse prostate cancer surgery have worse long-term survival

> >

> DETROIT ? Men who refuse surgery for prostate cancer and instead opt for

> " watchful waiting " ? monitoring cancer progression without undergoing

> treatment ? have a significantly worse long-term survival rate than those

> patients that choose radiotherapy, according to researchers at Henry Ford

> Hospital in Detroit.

>

> The study found that patients who refused any treatment for their prostate

> cancer had a 10-year overall survival rate of 51 percent, compared to 68

> percent for those who chose radiation treatment.

>

> " Surgery has been shown to offer a survival advantage to patients with

> prostate cancer when compared with other treatment options. However, a

> significant number of patients refuse surgery and instead opt for other

> treatments such as radiotherapy " says study lead author Naveen Pokala,

> M.D., an urologist at Henry Ford Hospital.

>

> The study was presented at the 2010 American Urology Association's annual

> meeting in San Francisco. >

> These findings follow a study published by Dr. Pokala in 2009 that showed

> surgery improves 5-, 10- and 15-year survival rates for men younger than

> 50 with moderately and especially in poorly differentiated prostate

> cancers, when compared with other standard treatments such as radiation

> therapy or watchful waiting.

>

> The new research, a population-based analysis of 9,704 patients chosen

> from the National SEER database, looked at survival rates among men with a

> mean age of 64.4 years, of whom 77 percent were white and 16.4 percent

> black.

>

> Of that group, nearly 30 percent refused any treatment for their prostate

> cancers, and about 70 percent chose radiation therapy.

>

> More than 70 percent of the patients were unmarried. In all, African

> American men older than 65 had the worst prognosis.

>

> Prostate cancer is second only to skin cancer as the most common cancer in

> American men, affecting one in six during his lifetime. The majority of

> the cases are in men older than 65, but it is becoming more prevalent in

> men under 40.

>

> It affects black men twice as often as whites, and their mortality rate is

> also twice as high.

>

> While curable in its early stages, symptoms often don't appear until the

> cancer has spread beyond the prostate gland itself, so annual exams for

> the disease are recommended.

>

> In addition to Dr. Pokala, study co-authors at Henry Ford Hospital

> included Peabody, M.D., and Mani Menon, M.D.